Provider Demographics
NPI:1982744587
Name:NOMIKOS, VASILIS (OTRL)
Entity Type:Individual
Prefix:MR
First Name:VASILIS
Middle Name:
Last Name:NOMIKOS
Suffix:
Gender:M
Credentials:OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 BLACKSMITH RD
Mailing Address - Street 2:
Mailing Address - City:LEVITTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:11756-3105
Mailing Address - Country:US
Mailing Address - Phone:516-390-5652
Mailing Address - Fax:
Practice Address - Street 1:41 BLACKSMITH RD
Practice Address - Street 2:
Practice Address - City:LEVITTOWN
Practice Address - State:NY
Practice Address - Zip Code:11756-3105
Practice Address - Country:US
Practice Address - Phone:516-390-5652
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012940-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist